Denial Management Specialist

About the Role Denial Management Specialist reviews and resolves denied patient insurance claims related to medical necessity, pre-certification, authorization, and level of care requirements. This role collaborates with physician practices, providers and payers to identify denial trends and manage the appeal process. What You'll Do

• Review and resolve denied patient insurance claims.
• Work closely with internal departments to determine accurate denial and appeals process.
• Contact insurance companies/payers or patients to gather information necessary to complete the appeal process.
• Send appeals to insurance companies by resubmitting corrected claims, submitting medical records, and writing appeals letters in a timely manner.
• Provide process improvement recommendations to Supervisor to decrease future denials.
• Utilize software tools to identify denial trends and payer issues; share findings with stakeholders.
• Follow up on pending claim denials after an appeal has been processed by the insurance company.
• Collaborate in data collection and send monthly “Managed Care Denial Report” to appropriate department Leaders including: Physician Coding Manager; Physician Billing Manager; Director, VP of EEH Physician Practices and VP of EEH Revenue Cycle.
• Maintain positive working relationships both externally and internally. What We're Looking For
• Education: High School Diploma (Required).
• Experience: 2+ years in patient billing or 2+ years in managed care.
• Skills: Extensive computer knowledge and experience; knowledge of standard billing guidelines, CPT/ICD9 coding, and Usual and Customary (U&C) schedules. Compensation & Benefits
• Salary: $22.14 - $33.21 per hour.
• Benefits include premium pay such as shift, on-call, holiday and more based on role; incentive pay for select positions; annual increases based on performance; career pathways for growth and development; tuition reimbursement; free parking; wellness program; health savings account options; retirement options with company match; paid time off and holiday pay; community involvement opportunities.